- Centene Corporation (Phoenix, AZ)
- …ensure appropriate care to members. Oversees and works with senior leadership on utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with… more
- Centene Corporation (Sacramento, CA)
- …experience with prior auth is highly preferred** **Position Purpose:** Directs the utilization management team to ensure the appropriate application of policy ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Ventura County (Ventura, CA)
- Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem ... Registered Nurse II/III - Utilization Management VCMC Salary $109,727.64 - $184,627.89 Annually Location Ventura and Santa Paula, CA Job Type Per-Diem Job Number… more
- CommonSpirit Health (Phoenix, AZ)
- **Responsibilities** The System Vice President of Utilization Management is a key member of the healthcare organization's leadership team and is charged with ... and accountability for creating, implementing, and leading an integrated system-wide utilization management program which includes comprehensive denials … more
- Centene Corporation (Columbus, OH)
- …IN STATE OF OHIO IDEAL CANDIDATE WILL HAVE PRIOR AUTHORIZAION OR UTILIZATION MANAGEMENT EXPERIENCE PEOPLE LEADER EXPERIENCE STRONGLY PREFERRED **Position ... to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more
- Alameda Health System (Oakland, CA)
- Director, Utilization Management + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day + Nursing + Req #:40826-30155 + ... plans **Role Overview:** Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight,… more
- Molina Healthcare (San Diego, CA)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- State of Indiana (Indianapolis, IN)
- Utilization Management Manager Date Posted: Aug 22, 2025 Requisition ID: 462259 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career ... health care and their communities. Role Overview: The role of Utilization Management Manager oversees the integration of utilization review, clinically… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Director, Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support ... onboardings with time sensitive requirements. + Support and grow the utilization management team through strong professional relationships, mentorship, modelling… more
- ERP International (Barksdale AFB, LA)
- **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for a full-time position supporting the 2d Medical Group, Barksdale ... organization, professional organizations, and community health care facilities concerning Utilization Management . + Participates in in-services and continuing… more
- Humana (Lansing, MI)
- …part of our caring community and help us put health first** The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent ... best and most appropriate treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates and communicates with Providers,… more
- McLaren Health Care (Indianapolis, IN)
- We are looking for a Utilization Management RN, to join us in leading our organization forward. McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of ... Inc. at https://www.mdwise.org/ . **Position** **Summary:** This position is responsible for utilization management functions. This includes but is not limited… more
- UPMC (Pittsburgh, PA)
- The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... in standard medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care. + Knowledge of… more
- Actalent (Santa Barbara, CA)
- …Plan Nurse Coordinator - REMOTE POSITION Non-profit healthcare network is looking for a utilization management registered nurse to join their team on a contract ... RN license + Flexible to work a 3-month contract + Medi-Cal Experience + Utilization Management WHAT'S IN IT FOR YOU: + Remote opportunity + Gain experience with… more
- Dignity Health (Bakersfield, CA)
- …but will be expected to work PST business hours.** **Position Summary:** The Utilization Management (UM) Trainer (Technical and Systems Focus) will be ... **Qualifications** **Minimum Qualifications:** - Minimum of 5 years experience in Utilization Management or related managed care functions. - Minimum of 5 years… more
- CVS Health (Charleston, WV)
- …members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the ... team maintains compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area + Implements clinical… more
- Humana (Boise, ID)
- …community and help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Actalent (Des Moines, IA)
- Job Title: Post Review Nurse - Utilization Management Job Description We are seeking a diligent and detail-oriented Post Review Nurse to perform timely ... utilization management reviews and claims assessments. This role involves applying InterQual criteria and medical policy to evaluate medical records and determine… more
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